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Astrocytic Activation as Evidence for Brain Damage

To the Editor: Andrew J. Dwork, M.D., et al. (1) found in their study that increased "cortical and hippocampal immunoreactivity for glial fibrillary acidic protein...was most intense in the group that received ECT" (p. 576). They wrote that these "statistically significant" increases in glial fibrillary acidic protein "probably" indicated "widespread astrocytic activation." In other words, 5 weeks after the last ECT, they found abnormal tissue changes under the microscope that were made visible by specialized staining techniques. This makes sense. Astrocytic activation is the brain’s well-known pathological response to injury and disease of all kinds.

Astrocytic activation evidenced by increased glial fibrillary acidic protein has been found in multiple sclerosis (2), temporal lobe epilepsy (3), amyotrophic lateral sclerosis (4), systemic lupus erythematosus (5), human immunodeficiency virus dementia, Alzheimer’s dementia, and, of course, traumatic injury.

Astrocytic activation, then called reactive astrocytic gliosis, was found after ECT as far back as 1948 (6). This latest finding of astrocytic activation 5 weeks after ECT is additional robust evidence in favor of brain damage—not against it.

References

1. Dwork AJ, Arango V, Underwood M, Ilievski B, Rosoklija G, Sackeim HA, Lisanby SH: Absence of histological lesions in primate models of ECT and magnetic seizure therapy. Am J Psychiatry 2004; 161:576–578[Abstract/Free Full Text]
2. Malmeström C, Haghighi S, Rosengren L, Andersen O, Lycke J: Neurofilament light protein and glial fibrillary acidic protein as biological markers in MS. Neurology 2003; 61:1720–1725[Abstract/Free Full Text]
3. Briellmann RS, Kalnins RM, Berkovic SF, Jackson GD: Hippocampal pathology in refractory temporal lobe epilepsy: T2-weighted signal change reflects dentate gliosis. Neurology 2002; 58:265–271[Abstract/Free Full Text]
4. Lexianu M, Kozovska M, Appel SH: Immune reactivity in a mouse model of familial ALS correlates with disease progression. Neurology 2001; 57:1282–1289[Abstract/Free Full Text]
5. Trysberg E, Nylen K, Rosengren LE, Tarkowski A: Neuronal and astrocytic damage in systemic lupus erythematosus patients with central nervous system involvement. Arthritis Rheum 2003; 48:2881–2887[CrossRef][Medline]
6. Riese W: Report of two new cases of sudden death after electric shock treatment with histopathological findings in the central nervous system. J Neuropathol Exp Neurol 1948; 7:98–100

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